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i <br /> du Environmental Health Department <br /> i <br /> SM <br /> P A4 <br /> QCOUNTY ii <br /> Greotn_ ess grows herd; <br /> TEMPORARY FOOD VENDOR ' S APPLICATION I <br /> All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br /> the festival coordinator three (3) weeks prior to this event. <br /> 1 . 1 . Name of Event: _ <br /> LODI GRAPE FESTIVAL <br /> 2 , The following Is information about my organization/business: <br /> 1 <br /> Name of organization/business: <br /> Address: <br /> // r L'_ •� I.9 <br /> i <br /> Phone: (�. � } , �� -�y Alternate: <br /> 3 . List food to be sold or given to the public: P N <br /> 4. I am providing food that is NOTprepared at home: Yes [I No <br /> All food is prepared on-site or is from approved commercial facilities: [f� E � No <br /> p <br /> Name of facility: Phone ' i <br /> Address of facility: <br /> 5. I am providing a booth with the following: (to protect my unpackaged food and food preparation areas from flies , <br /> dust and the public) <br /> ❑ A booth with walls and ceiling constructed of either woad , canvas , plastic, similar material and fine mesh fly <br /> screening , completely enclosing open food areas . It will also have a smooth and cleanable floor (concrete , <br /> asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br /> areas from the public. <br /> © Other (specify) : rX <br /> Note : The only operations not required to provide enclosed booths are those which sell beverages from <br /> approved dispensers , or prepackaged foods from approved sources. <br /> 6. Approved water for drinking , utensil and hand washing will be provided in my booth by the following methods : <br /> ❑ Approved bottled water. <br /> Q On-site hose bib that is connected to a potable water source. <br /> ❑ Other (specify): <br /> 7. Electricity is provided for my booth's use: Yes ❑ No <br /> 80 i am providing an accurate probe thermombtefiAb measure the hot and cold holding of potentially hazardous I <br /> foods during all times of booth operation: VrYes ❑ No <br /> 9 . 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 135° F : <br /> ❑ Camp stove ❑ Sterno & hotel trays <br /> ❑ Double steamer ❑ Steam table & fids/ <br /> ❑ Electric stove top ❑Other (specify) <br /> Note: Examples of potentially hazardous food Include : meats, tamales , cooked beans , rice, <br /> vegetables, potato salad , eggs, and dairy products. <br /> 1868 E . Hazelton Avenue I Stockton , California 962051 T 209 468-3420 1 F 209 464 -0138 WWw•SJ TEMP EVENT APP <br /> EHD 16-02 Page 7 of 11 <br /> 0713117 <br />